Like political analysts, psychiatrists are interested in statements that do not conform to
consensual reality, or to put it plainly, lying. Political thinkers parse lies for their identifiable strategic purpose: to
conceal wrongdoing (“I did not have sexual relations with that woman” ) (Clinton,
4/8/2012) or to advance an agenda (“The murder rate in our country is the
highest it has been in 47 years” ) (Trump 2/8/1027). http://www.politifact.com/ Exposing the truth effectively counters strategic lies.

But how do we understand the reflexive lies, easily and
readily disproven, that spew from our president’s itchy twitter finger? Even
when the evidence is incontrovertible, he sticks to his version of reality,
about everything from the size of his inauguration crowd to his recent denial
that he said what he said about Haiti and countries in Africa in front of an audience
of US senators.

The question of why people from senators on down so readily
accept, forgive and rationalize a leader’s lies is another legitimate focus of
political analysis. As someone with professional license to think
about non-rational motives for behavior, I am more interested in the question of
whether Trump even knows he is lying.

Trump’s behavior is at least consistent with deficient
capacity for mentalization. Mentalization is a newish concept in the
psychotherapy literature, with implications for understanding socially
undesirable and self-defeating behavior of many kinds. Moreover, high status strains the capacity for mentalization, even in those who showed no impairment before being
elevated to positions of leadership.

Influential psychologists and psychiatrists define mentalization
as the capacity to perceive and understand the difference between inner
experience and the experiences of another person. The opposite is belief in an
exact correspondence between one’s own mind and the world outside. None of us
could live in the world if we did not reflexively credit our perception most of
the time, but when experience contradicts perception, mentally healthy people
adjust their inner reality to absorb new facts. By contrast, the ability to recognize when material or social reality contradicts perception or belief may
be seriously deficient in people across a wide spectrum of mental disorders.

Irony, humility, and self-awareness flourish in the cracks between
belief and outside reality. When no space exists, these qualities wither and
die. People with schizophrenia often lack
a sense of humor. Therapists know not to try to make jokes when treating
someone with a severe personality disorder. Famously unable to display
humility, Donald Trump also seems to suffer from a serious irony deficiency, suggesting
his capacity for mentalization falls well outside the range of normal.

Diminished capacity for mentalization may help explain how
and why Trump lies so shamelessly. People
who cannot perceive the difference between what they believe and the world as
it is lie without awareness that they doing so. Even while propounding wild
untruths, this lack of awareness makes them seem authentic and sincere. People
capable of doubting their own views, by contrast, risk appearing inconsistent
or hypocritical. Deficient capacity for mentalization thus fosters a world of
principled hypocrites and plausible liars.

Like every other mental quality, the capacity for
mentalization presumably results from genetic endowment, modified by
experience. Also like every other mental capacity, current circumstances will
magnify or suppress whatever traits a person brings to the political arena. Trump’s
current role as a leader may reinforce his presumed earlier deficiencies.

When a complex organism, human or otherwise, is threatened
or traumatized, a basic, evolutionarily conserved, hard wired neural process
narrows attention to focus on cues related to threat. This process excludes awareness of the context
of the threat, or signs of support and security. Arguably, being a leader in
and of itself stresses even well evolved capacities for mentalization. High
level leaders, like alpha primates, may be exquisitely attuned to
threats to their dominance. In response, they choose their associates to avoid
contact with those who might challenge them. Politicians at the highest level even
have some capacity to influence reality, at least media representations of
reality. Controlling interactions and the flow of information creates a
reverberating circuit, in which the leaders’ distorted views come back to them
as outside influence, making their distortions ever more inflexible. Understood
in this way, Trump may not be lying, at least in the strategic sense, when he
denies the truth.